MEDICARE: RAPHA NURSING & REHABILITATION CLINIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	008552	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780781716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPHA NURSING & REHABILITATION CLINIC, INC

Provider Business Mailing Address
First Line	:	11000 FONDREN RD
Second Line	:	C-5
City	:	HOUSTON
State	:	TX
Zip	:	77096-5513
Country	:	US
Telephone Number	:	713-776-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11000 FONDREN RD
Second Line	:	C-5
City	:	HOUSTON
State	:	TX
Zip	:	77096-5513
Country	:	US
Telephone Number	:	713-776-2500
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SAMUEL FUNSHO FADIPE
Credential	:
Telephone Number	:	713-776-2500

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/11/2011

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